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Post: Blog2_Post

When therapy does more harm than good.

Updated: Oct 30, 2023

A few weeks ago I wrote a blog called How to get more clients (and fill your solo private practice) Pt 3: Affiliates and referral sources. In that blog post I talk a LOT about getting word of mouth referrals.


After it went live I got an email from a reader. His question brought up a discussion on the true nature of word of mouth clients and what happens when therapy does more harm than good.

Enjoy!

 

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Q: Do effective therapists really have good word of mouth?

Great post, as usual, Jordan. Really nicely laid out here. You are great at testing and actually looking at the data, which I really admire.


I had a thought as I was reading this section:

Are you really that good? In general 50% of clients experience some change while in therapy with only 25% recovering. So if you're seeing 20 clients a week then only 5 of them have recovered, but you can't ask them directly for clients. So they'd have to be so blown away that your name instantly comes to mind when a friend says "hey, I need a counselor."

I think there's an assumption here, that if someone is referring a friend, it's because of good outcomes. I don't know if this is actually true. Could there be other reasons someone has good word of mouth? Maybe they're great at validating the client and vilifying their partners as the problem, so the client feels really good about the therapist? Just curious what you think other reasons could be that clients send their friends...


If it's truly directly correlated (or maybe caused) by how good the outcomes are, then our work should be directed toward increasing outcomes. If it's other factors, like how validating or likeable etc., then I think we would focus on other aspects, assuming our goal is to have full practices, not produce the "most change" possible.

-G

***

A: Therapists word of mouth is (probably) built in the little moments.

G,

I love this question!


First I'm pretty certain that if clients get better they are likely to refer their friends. But you're pointing out a very important nuance:


There are lots of therapists who probably aren't effective but also get enough referrals.


These therapists are probably experts not at change but at interpersonal dynamics. This is a little heady, so hang in there with me. Sometimes clients overtly signal they need validation.

They might say something like:


"My heart is broken. I didn't know I could hurt so much."

"I'm so sorry for your loss. It makes sense to feel so much pain."


But there are also covert ways clients signal they need validation. They might say something like:


"I know this is stupid."

"I can't stop crying."

"I don't know what's wrong with me."


In these moments clients are actually saying, in a roundabout way, "I'm feeling a little self critical about my vulnerability." Let's call these hidden requests for reassurance. A therapist who is a expert at interpersonal dynamics might respond:


"I don't think this is stupid. Something big is happening to you right now."

"These tears tell us something important is happening."

"It makes sense to me you feel this way."


When we respond to these hidden requests for reassurance we subtly but profoundly build the therapeutic bond {link}. Responding well in these moments undoes a bit of the self critical voice clients carry and lubricates therapy so clients can talk about shame and self criticism without drowning. Statements like these (and others) are part of a basket of skills called Facilitative Interpersonal Skills (FIS).


Now to your actual question:

Could there be other reasons someone has good word of mouth? Maybe they're great at validating the client and vilifying their partners as the problem, so the client feels really good about the therapist?


I suspect you're correct. I think lots of therapists are actually experts at these interpersonal dynamics, but in a non-therapeutic way. So saying, "Your husband shouldn't have said that to you, it sounds like he might have a touch of narcissism?" can be incredibly attuned to the micro-nuance of a wife's pain, but it subtly turns her against her husband.


Granted there are plenty of times when a partner, out of their own trauma, becomes the villain. To help a client acknowledge that sometimes the pain they experience isn't their fault can be incredibly healing.


Still every advance has a dark side. And I suspect more therapists than we'd like to admit are bonding with their client by vilifying someone else.

I think the public knows this too.

Best,

Jordan (the Counselor)

-Fin-


 

If you liked this post, consider reading this next. I think you'll like it ;) It's more about marketing your practice.

 

Jordan Harris, Ph.D., LMFT-S, LPC-S is the lead author of the book Deliberate Practice in Multicultural Therapy. Dr. Harris is also co-developer of the Numerapy Model, a coaching program teaching therapists how to leave community based work and start their own solo counseling practices. Dr. Harris runs a solo counseling practice (Harris Couples Counseling, Marriage Therapy, & Private Practice Coaching) in Northwest Arkansas where he specializes in working with couples.

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